| Florida Institute Of Oms | |
|
2402 Frist Blvd Ste 100 Fort Pierce FL 34950-4838 | |
| (772) 461-9700 | |
| (772) 461-9300 |
| Full Name | Florida Institute Of Oms |
|---|---|
| Speciality | Oral & Maxillofacial Surgery |
| Location | 2402 Frist Blvd Ste 100, Fort Pierce, Florida |
| Authorized Official Name and Position | Tanya Gonzalez (PRACTICE MANAGER) |
| Authorized Official Contact | 7724619700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Institute Of Oms 2402 Frist Blvd Ste 100 Fort Pierce FL 34950-4838 Ph: (772) 461-9700 | Florida Institute Of Oms 2402 Frist Blvd Ste 100 Fort Pierce FL 34950-4838 Ph: (772) 461-9700 |
| NPI Number | 1558429753 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 01/31/2024 |
| Medicare PECOS PAC ID | 1850482092 |
|---|---|
| Medicare Enrollment ID | O20070802000321 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558429753 | NPI | - | NPPES |
| DN 16376 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Secondary |
| 204E00000X | Oral & Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Takashi Koyama |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1356459028 PECOS PAC ID: 4880668417 Enrollment ID: I20040820000437 |
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